Posted at 10.30.2018
As health professionals, every day our company is invited to face patients delivering different problems and which need various solutions or treatments such as medical treatment, information giving, educating, counselling, etc. I am a trained nurse in dialysis and renal pathologies management and I work in dialysis device of our clinic. My main role is to receive patients with renal pathology and lead them to the Nephrologist, to plan and execute approved treatment for many who are diagnosed with renal inability. That treatment concerns in general renal replacement therapies like hemodialysis or peritoneal dialysis. For the following work, I've chosen one of your patients due to following reasons:
He is an individual anguish of end level renal disease and undergoing dialysis treatment since 24 months, he handed down the first time under peritoneal dialysis but after developed chronic peritonitis and for this he has been moved for hemodialysis.
He is waiting for renal transplantation however now lacks fund needed for the process
Because of peritonitis he has received painkiller drugs for a longtime to relieve pain but he completed by developing habit to painkillers. Still now he is constantly on the claim for painkillers since there is no valuable reason.
He presents indications of nervousness and depression
Identifying client's problem is the main element of the success of counselling process. Problem exploration is an important step, because it permits counselor-client first contacts also to map out the client's problem. For this, all the procedure needs to be well prepared. The planning concerns your client and the surroundings in which guidance will be given. Concerning my client prep, to get his consent, I have before all discussed him what is counselling and what its benefits are for individuals undergoing it. Concerning the environment, all counseling sessions took place inside our service, in one of our offices that I have chosen because it's peaceful, well illuminated and aerated and where distracting conditions have been eliminated. We used seats permitting to get various positions but each time it was possible, I established them in manner to permit in person interaction. This agreement allows us to avoid distractions also to have a complete opened interaction. Counselling sessions were arranged to possess place before every hemodialysis program, and I tried out to avoid they went over thirty minutes. This has the reason to permit my customer to begin quietly his hemodialysis period.
My consumer MV is a adult presenting various problems. After having a careful analysis, I came across that my consumer has various issues which have to be fixed by himself or through assistance from other folks. Here, I found that neededassistance could be categorized as pursuing:
Problem necessitating other help than counseling
Treatment of End level renal disease: the management of that condition is accomplished generally by medication, diet therapy and renal replacement unit remedy. The initiators of the procedure are Medical doctors (Fink et al. , 2001).
Problems which might find solution with counseling
Addiction to painkiller drugs: treatment by painkiller commenced while my consumer was treated by peritoneal dialysis. He developed persistent peritonitis with intolerable belly pain. For the pain he received painkiller every time he claimed it. After stopping peritoneal dialysis and starting hemodialysis, my customer is constantly on the ask painkiller although we don't visit a real reason for it. We figured he has developed dependency to painkillers. Understanding a variety of models and theories of dependency and other problems related to product use, describing helping strategies for reducing the negative effects of substance use, abuse, and dependency are among competencies of any counselor in addiction (U. S CSAT, 2005).
Problem which may find solution in mixture of medical assistance and counselling:
Anxiety and despair which relating to my examination are scheduled to:
Waiting quite a while the renal transplantation without hope to find financial assistance for the procedure.
Thinking to be pointless for the family
Anxiety and fear of the future: before he noticed sick, he would begin university or college studies and has been obliged to stop them
Brusque stop of painkiller treatment
Cucor D. et al, (2007)recognized that depression is one of common mental medical condition for individuals with End-stage renal disease. According to them, depressive disorder is one of factors influencing morbidity and mortality rates among those individuals.
Various medications are being used to fight stress and anxiety and melancholy but to be more effective, medication need to be coupled with other therapies like behavioral treatments. When associated, both medical and behavioral therapy, patient benefits from better decrease in symptoms and a smaller threat of setback (http://helpguide. org/mental/anxiety_types_symptoms_treatment. htm).
The client has developed dependency on painkillers drugs and has been appreciated to avoid them with no psychological assist with help him to do delicate withdraw from medicine taking. According to my diagnosis and quite a while passed with your client, it's for your problem that my client must be helped first of all and it's about this I've chosen to work with him as also he has wished. It might be a hard job, but this will help the client and will help me to obtain additional experienced because we are lacking experienced counselors.
During counseling lessons, the counselor uses various techniques to interact with his consumer. Communication and connection management skills are being used during counseling discussion and their use depends upon how the period is going. Here below is a short transcript of 1 session I needed with my customer.
Myself: you come just to present me problems that are stressing your daily life, could you notify me now about the intensity of each problem?
Here I've used questioning skills to help my client to express himself and explore issues relating to his problems.
Client: As I told you in the last session, I have been suffering from persistent renal failure there are now more than three years. As you see it, I am young and I had been about to get started my university or college studies when I felt ill. At the start, I was confident even though my doctor possessed explained that I am going to need permanent treatment. Now when I think about my future, Personally i think hopeless. My studies ceased, I lost big money with treatment, and I don't possess money for renal transplantation, and then for my unluckiness although he is aware of that I am suffering the doctor has quit my shots of painkiller.
Myself: I am aware you feel overburden by those problems; according for you which problem is mainly troubling your life? What are your main concerns?
Client: actually it's my constant unrelieved pain.
Myself: Can you briefly speak about that pain?
Here, centering skills to bring my client to give a clear definition of the situation that he needs our help.
Client: you may already know it, I have started out treatment with peritoneal dialysis. After 5 weeks of treatment I developed peritoneal contamination which was creating me serious pain. Other patients who possessed the same problem in the past suggested me to ask to my doctor to suggest me Pethidine which relieves pain and permits to sleep.
Here, active tuning in skills helped me showing to my client that we am mindful of what he is telling me.
Myself: how have you appreciate the treatment with Pethidine?
Here also I used questioning skills to get full information which can help me to analyze the partnership between my client's problems and his health background.
Client: at the start it was wonderful to not feel pain and I was again able to close my eyes and rest.
Myself: and after?
Client: after, it became impossible for me to rest without my injection and one injection a day had not been sufficient for me. Because of this, all the day I used to be harassing my nurse to provide me Pethidine.
Myself: You told me that whenever you start treatment with Pethidine everything was ok, no pain and you were able to sleep. So, how does you take it when the Nephrologist decided to stop Pethidine injections for you?
Here I used summarizing skills to help my consumer to stay fixed on our subject; 'pain'. I asked him that question as challenging to see if he'll continue to inform me that he still needs Pethidine injection.
Client: it's been a bad moment for me and up to now I hardly understand him because I am still sensing pain.
Myself: how do you feel if you are your own house?
His family members have told me that he's quite at home and statements to feel pain only when he happens in medical facilities. I needed to get profound information about his pain.
Client: Not very bad. I feel exaggerated pain while i come for treatment.
In this work, I have been using the client-centered way. That way of counselling has been conceptualized by Carl Rogers (1946). The essential belief becomes around the theory that each individual innately strives towards personal actualization, in the other words to be the best that he can.
Essentially the individual or child centered approach extends the central conditions of empathy, no conditional positive regard and congruence to your client, facilitating, in a reflective and non directive way the client's exploration and harmonizing of his psychological and personal issues that contain been arisen from his life's experience.
The target is, to help the client to stop the personal image which he has built around his specific experiencing (Mearns D. & Thorne B, 2000 p5).
This approach considers a customer as an active agent, able to take responsibility for his own condition. Palmer reinforces this when he notes '' clients should explore their most intimately used opinions and principles, in order to discover for themselves, what it is that matters to them, what it is worth living for or what would be worth dying for'' (Palmer, 1996:p31).
The esteem of client is essential in this process. Matching to Corey (1977) the strength of this approach come from its capacity to concentrate on personal preferences and pathways going for personal development. Emphasis is on flexibility, responsibility and the individuals capacity to redesign his life through attentive choice.
The counselor-client relationship is also essential to good practice of client-centered methodology. To get involved effectively in counseling, Freshwater (2003) claims that nurses necessitate to recognize your client as the same, though as clients often view nurses as experts it can make this relationship difficult to acquire.
Through this work I have already been using the ideas of motivational interviewing counselling, in which the main objective of the counselor is to recognize and work with the client's motivation to change. Motivational interviewing builds on Carl Rogers' optimistic theories about people's capacities for exercising free choice and changing through an activity of self-actualization (Liquor answers, 21. 8. 2009).
The healing relationship counselor-client is a reciprocal collaboration. The counselor's role in motivational interviewing is directive, with a goal of eliciting self-motivational claims and behavioral differ from the client in addition to creating discrepancy to improve inspiration for positive change (Miler and Rollnick, 1991).
As professional medical providers, we tend to be asked to act as change agent for our patients, students, and acquaintances. Whenever we play that role we try to help people make necessary behavior changes by instructing them in the whys and hows of earning them. We may have been trained to think that if we simply show our patients what they have to do to improve and do it effectively enough; they will change (Ellen R. Glovsky, and Gary R. , 2007).
In our day to day work, inclination is to think that our clients need only medical assistance, but when we try to analyze the situation, we may find that we are wrongful. All clients' needs aren't answered by medicines or other medical and medical interventions. More often than not, we disregard the socio-psychological facet of the problem. That is remarkable with chronic renal diseases like end stage renal failing, diabetic nephropathy, tumors, etc.
Sensky (1993), in his work, exhibited how renal failure influences on person's life. The impact doesn't only concern the physical condition but the entire person. With renal failing, various modifications come in the life span; the patient has to learn new skills and strategies which can help him to cope with his condition. The patient has to try to adapt to his chronic disease and the necessity to cope with dependence on dialysis machine or other else's kidney to keep to live a life.
In their works, (Levenson, 1991; Kimmel, 1993, and Finkelstein, 2002) know that anxiety and unhappiness are the most common subconscious problems in dialyzed patients. A similar idea are available in the task of Chilcot and his acquaintances. They found 20% to 30% of End level renal disease patients with signs of major depression at various levels (Chilcot, & Al. , 2008).
The other problem within patients undergoing long term dialysis is a possible dependency on pharmaceutical drugs like painkillers (Manjula, Bennett, Chertow, 2003).
Addiction is thought as a state seen as a impaired controlover the utilization of substance and/or behavior. This business lead the addict to seeking and abuse of drugs, a need to continue to take drugs to which somebody is becoming habituated following a repetitive utilization since it produces some special effects like euphoria and other types of mental status alteration. Clinical manifestations occurbeside physical, psychosocial and spiritual dimensions (University of Doctors and Doctors of Saskatchewan, 2008).
Addicted substances are like alcoholic beverages, stimulant substances like cocaine, heroine, marijuana, and medications like tranquilizers and painkillers. Others may habitually merge prescribed drugs with liquor to numb the mind from keeping on disappointments or personal issues. Many people persist in taking medications to feel better physical or psychologically even when no ailments are present; and some demand that they can't function without them. Information indicate that, the amount of visits in er for prescription and unlawful drugs overdoses will be the same and that each abusing medical drug like codeine can be equally addicted as the one who abuses of unlawful drug like cocaine. While prescribe drugs is completely legal, honest and moral laws and regulations prohibits the use of medications for purposes apart from the original target. Addicted people need therapists specialized in chemical dependence guidance and who can help them to recover from the craving by reviewing previous health background and patterns of substances mistreatment. More often than not counselors find that long term maltreatment has produced undesired emotional and physical results. The case provided above concern an individual dependent on Pethidine, a painkiller of opioids pharmacological family. Addiction to opiates like morphine may appear after long-term pain suffer is given dosages to regulate acute soreness, and persists its use long after pain has collapsed (ChristiaNet, 2009).
Many people who have long-lasting pain receive treatment by opioids. But, there are data throwbacks and part effects which could follow this treatment. Developing tolerance to drugs is one major risk, sometimes at short time. The second major risk is the introduction of addiction. Addicted people to painkillers becomeso fixated on getting ultimately more of them that the obsession prevail above the medical goal of relieving pain (Multimedia Planet, 2009).
The concentrate of individual drug guidance is on the symptoms of chemicals addiction. It also relates areas of weakened function and the framework and content of the client's ongoing rehabilitation program. The first aim for of counseling in habit is to aid the addict to attain and maintain abstinence from addictive substances or behavior. The second concentrate on is to aidthe addict to recover from damages that have caused by craving in his life (Delinda E. & Georges W. , 1999).
The addict's counselor works first of all by helping your client to understand the reality of an problem and the linked unfounded thinking. Within the next steps, consumer is stimulated to accomplish and uphold abstinence from addicted chemical or behavior. This assists to build up needed psychosocial abilitiesand spiritual growth to remain in healing process (Delinda E. & Georges W. ).
Counseling as a assisting process consists of 3 main phases. Each stage has its distinct aims although same skills can be utilized in those 3 phases. Those three main stages are:
Exploration, evaluation and planning phase
In this phase, the main targets are to apprehend the client all together person, to plan counselor's interventions, and also to arrange an agreement between counselor and consumer.
Rehabilitation guidance and goal success phase
Counselor's targets in this period are the initiation and execution of his treatment solution in collaboration along with his client.
Termination and analysis phase
In the shutting phase, objectives are to summarize treatment process and deliberate its end result with your client, and to set up agreement on future actions.
In addiction guidance, the aims of the all process are to rehabilitate your client from the addicted product or behavior and to avoid the relapse.
Rehabilitation may be thought as the process consisting in recovering the capacities that contain been reduced due to accidents or health issues. The restoration is sustained only once there is absolutely no relapse or get back into addicted substance or patterns. Here, the purpose of counselling is to lead your client to a full reintegration into his community as dynamic and respected person. Each and every time it's possible, detoxification comes first, and after can be started out the laying of the basis of treatment process. Abstinence from addicted compound or tendencies is insufficient in itself. The addict has to see the gains of keeping abstinent; otherwise they can relapse at short or long term (United Nations International Drug Control Program, 2003).
Individual addiction guidance doesn't only give attention to stopping or minimizing addicted chemical or behavior. It will addresses the other related domains of impaired working and those are such as interpersonal relationships, illicit activities, career position, etc. When additional helps are needed, the counselor is preferred to refer your client (U. S Country wide institute of Health, 2009).
Above, I've mentioned that counseling process has to help client to maintain abstinence following the recovery period, in any other case your client can relapse and go back in cravings.
What is a relapse?
There is a relapse when, a client in recovering period or in post recovery, results to the addicted product/behavior or becomes dependent on a new element.
Prevention of relapse in guidance process
Preventing relapse is a very important element of recovery. When the client becomes able to set up some constancy in abstinence, he could begin to develop skills to put off future relapse to addicted chemical/behavior. To prevent relapse, the addict should be taught how to recognize in advance, when he's headed near a relapse and also to modify span of events. Through counselling process, by education, the addict can identify indications of coming up relapse. Those indications are like negatives changes in client's patterns, feelings and behaviour. Once the client became conscious of the environment of relapse process, his next mission is to develop the abilities to intervene and change any happening negative behavior or emotions (Delinda E. & Georges E. )
I am not a professional or trained counselor. I am only a student in nursing studies who is trying to apply learnt guidance skills. I have chosen to utilize my client about his addiction. I understand it's a very complicated subject for a novice in guidance, more experience is needed. Difficult to handle that subject has activated and encouraged me to do further reading and researches concerning addiction; what is it, its causes, its management by the combination of counseling and different ways of help like pharmacotherapy. During my counseling process, in my client's needs diagnosis; I got more affected by medical aspect of my client's problems. The public situation of the individual has not been full analyzed and I think that this can somewhat weaken the problem exploring process. The second difficult is to learn borderline between involvement domains of a specialist counselor and a doctor who applies guidance skills to help a customer. We may think that it's easy however in practice it is rather complicated. You ask yourself: "Does the client's problem need a professional counselor or an experienced doctor can help?''
This may lead us to be fluctuating inside our practice. I suggest here to insist on this point during elaboration of "Professional practice and guidance skills module". My power now reside in fact that I can now lead counseling process without apprehension, methodically and without requesting about the start or next phases. To help my consumer, I didn't consider medical data as enough to conclude that my consumer is addict. I have spoken with my consumer but it was essential to know very well what his family considers him. For this, I had debate with some users of his family about my client's problems and needs. From your family I received information reinforcing the medical prognosis of obsession. I consider this as a confident point, because we must check the all environment of consumer to get real and full information which can help us during counselling process. Shortly time after the start of my counselling sessions, my consumer begins to withdraw steadily from his constant obsession to get Pethidine treatment and stop to recommend other patients to ask that medicine. He was suffering from end stage renal disease; a long-term condition so we'd many counseling periods to avoid relapse. We didn't continue steadily to interact; he died before the termination in our counselling process; but all this process has been helpful for him and filled with experience for me personally.